Hội chứng antiphospholipid; những ảnh hưởng của nó đến bệnh tim mạch: một bài tổng quan

Journal of Cardiothoracic Surgery - Tập 5 - Trang 1-10 - 2010
Ioanna Koniari1, Stavros N. Siminelakis2, Nikolaos G. Baikoussis1, Georgios Papadopoulos3, John Goudevenos4, Efstratios Apostolakis1
1Cardiothoracic Surgery Department, University of Patras, School of Medicine, Patras, Greece
2Cardiac Surgery Department, University of Ioannina, School of Medicine, Ioannina, Greece
3Department of Clinical Anaesthesiology and Intensive Postoperative Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
4Cardiology Department, University of Ioannina, School of Medicine, Ioannina, Greece

Tóm tắt

Hội chứng antiphospholipid (APLS) là một hội chứng hiếm gặp, chủ yếu được đặc trưng bởi một số biến chứng huyết khối tăng đông và do đó, liên quan đến bệnh nhân phẫu thuật tim mạch. APLS bao gồm các đặc điểm lâm sàng như thrombosis động mạch hoặc tĩnh mạch, bệnh van tim, bệnh động mạch vành, hình thành cục máu đông trong tim, tăng huyết áp phổi và bệnh cơ tim giãn. Van bị ảnh hưởng nhiều nhất là van hai lá, tiếp theo là van động mạch chủ và van ba lá. Để chẩn đoán APLS, việc phát hiện kháng thể antiphospholipid (aPL) như kháng thể anticardiolipin (aCL) hoặc lupus anticoagulant (LA) là điều thiết yếu. Những thay đổi nhỏ trong quá trình điều trị chống đông, nhiễm trùng và căng thẳng phẫu thuật có thể khởi phát cơn thrombosis toàn thân. Tỷ lệ thrombosis cao nhất trong các giai đoạn phẫu thuật sau: trước phẫu thuật trong thời gian ngừng warfarin, sau phẫu thuật trong giai đoạn tăng đông mặc dù có điều trị warfarin hoặc heparin, hoặc sau phẫu thuật trước khi đạt được sự chống đông đầy đủ. Bệnh lý van tim bao gồm sự dày lên không đều của các lá van do sự lắng đọng của các phức hợp miễn dịch có thể dẫn đến sự hình thành thực vật và chức năng van bị suy giảm; đây là một yếu tố nguy cơ đáng kể gây đột quỵ. Bệnh nhân mắc APLS có nguy cơ cao hơn về thrombosis và việc kiểm soát chống đông đầy đủ là vô cùng quan trọng trong suốt quá trình tuần hoàn ngoài cơ thể (CPB). Một kết quả thành công đòi hỏi phải quản lý đa chuyên ngành nhằm ngăn ngừa các biến chứng huyết khối hoặc chảy máu và để quản lý chống đông trong quá trình phẫu thuật. Cần có nhiều nỗ lực và báo cáo hơn về việc quản lý chống đông và liệu pháp hỗ trợ cho bệnh nhân mắc APLS trong suốt quá trình tuần hoàn ngoài cơ thể.

Từ khóa


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Journal of Cardiothoracic Surgery

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